The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension
Article first published online: 26 NOV 2012
© 2012 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 15, Issue 3, pages 162–170, March 2013
How to Cite
Michaelides, A. P., Liakos, C. I., Vyssoulis, G. P., Chatzistamatiou, E. I., Markou, M. I., Tzamou, V. and Stefanadis, C. I. (2013), The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension. The Journal of Clinical Hypertension, 15: 162–170. doi: 10.1111/jch.12035
- Issue published online: 4 MAR 2013
- Article first published online: 26 NOV 2012
- Manuscript received: August 19, 2012; revised: September 24, 2012; accepted: September 26, 2012
J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc.
Delayed blood pressure (BP) and heart rate (HR) decline at recovery post-exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non-CAD patients (374 normotensive) were followed for new-onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow-up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New-onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28–2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08–2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03–4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14–4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components.